Provider Demographics
NPI:1023419215
Name:COLLINS, HERBERT L II
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:L
Last Name:COLLINS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 S 133RD EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74134-5422
Mailing Address - Country:US
Mailing Address - Phone:918-231-4623
Mailing Address - Fax:
Practice Address - Street 1:1535 S MEMORIAL DR
Practice Address - Street 2:SUITE 111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-7002
Practice Address - Country:US
Practice Address - Phone:918-660-0255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management